I was wondering if you have patients with chronic
depersonalization/derealization. I've had derealization for about 7 years.
About one year ago, I found that Lexapro was the only drug that would alleviate
the Derealization, while 99 percent of them would make it worse. Unfortunately
it put me in my first mani/hypomania. I began to see a prominent bipolar doc,
and she would not allow SSRIs, at least not til stable.

Depakote seemed to clear it up too, but i could not take the side
effects. I'm working my way up on the lamictal, then hoping to add the lexapro
in the future.

I was wondering about your thoughts of derealization, either as a
symptom, or a disorder in itself.

Regards,
Brian

Dear Brian --

Probably quite a few experiences could fit under that heading of
"derealization". So I won't presume to know exactly the nature of the
experience you're describing with that term.

Generally, derealization and depersonalization are symptoms which
people have for brief periods of time. They are widely recognized to occur
during panic attacks, for example.

From the sound of it, making a bit of a guess here, your symptoms
are more continuous than that. Again, making a bit of a leap, it sounds like
they might actually be part of the bipolar experience itself. That would be of
course more likely if they occurred along with other symptoms of bipolar
disorder, like big changes in sleep or irritability or mood.

If we presume for the moment that depersonalization when the
realization are symptoms of bipolar disorder, it would make sense that
antidepressants made it worse and Depakote made it better. In that case, just
keeping the focus on treating bipolar disorder in the standard way (relying on
mood stabilizers, avoiding antidepressants) would be the obvious way to proceed.

On the other hand, these could be a separate issue. These
symptoms are also often seen in posttraumatic stress disorder (PTSD). PTSD is a
common co-traveler with Bipolar disorders.

Your course of action might be pretty much the same either way:
based on your reaction with Lexapro, a bipolar component sounds very likely. In
that case, you are rather forced to begin with a mood stabilizer. The good news
is that -- based on your experience with Depakote -- it may well take care of
the symptoms without having to incorporate something like Lexapro.